need data on VBAC after CPD/dystocia

[mollikins]

I have been trying to find specific data on the success rates of VBAC when the previous c-sec was due to dystocia. With my daughter, I dilated to 10 cm, pushed for 2.5 hours (flat on my back of course), and had a c-section.

My brother-in-law, who is an OBGYN, insists that my potential success rate for VBAC with this pregnancy is only 13%. I have found that citation (Hoskins 1997) as well as one other study that shows a 44-58% success rate (Puliyath 2009).

I know you ladies are rock stars of medical journal research, does anyone have any other articles I can use? Thanks in advance!

btw...with my first labor, my water broke at only 2 cm dilated. I laid in bed for my entire labor b/c the nurses scared me about the risk of cord prolapse : and I pushed on my back b/c they told me I had a better chance of getting the baby's head over my pelvic bone that way. Is it any wonder she got stuck in the birth canal????

[MsBlack]

Have you looked into ICAN--international cesarian awareness network? They are your best bet for current research and support for VBAC. Sure sounds to me like you had a medically unnecessary, iatrogenically caused csec in the first place. "13% chance of successful VBAC", my hind foot! So speaketh the OB--and um, wasn't it OBs who gave you your first experience anyway?

Do look into ICAN--not only for refuting your OB relative and others who are concerned, but also for the real skinny on VBAC and real support for it, too. Tons of women have vbacs every day after all kinds of reasons for csec. "Dystocia" is a wastebasket diagnosis anyway--it really only means "under currently imposed medicalized birth conditions that are contrary to maternal-fetal wellbeing and contrary to the efficiency of birth, this mama could not meet our timeline for birthing". Gah.

ican-online.org

Sounds like you know now what you wish you would have known then. Don't let the naysayers get to you! Your BIL may or may not be convinced--if not, just tune him out.

[E-man's mama]

I don't have any statistics for you to give to your BIL, I'm sorry. But in the words of my wonderful midwife, "Your baby is not a statistic."

I had the exact same situation as you except I was induced. But that led to a host of interventions, including epi and then pushing for 4 hours, which led to the c-sec when I couldn't push his big old posterior head out!

But, 2.5 years later I had a super speedy natural VBAC and about 2 minutes of pushing (well, about 20 minutes of being told NOT to push while waiting for the midwife!). So it wasn't that my body couldn't do it, but just that it wasn't the right time nor the right position for my first baby.

In my case, I always wondered if I could push a baby out, and for me, I just wanted to try again. I would have always regretted not trying if I had just scheduled the c-sec. So you can tell your BIL that you want to try and if the baby gets stuck again (which it probably won't because you are more educated now and can work proactively to prevent it) then at least you know you gave it your best shot. Or you can just tell him to shove it cuz its your body and your baby and you'll do what you know is best But you can say it nicely of course!!!!

Anyway, good luck. I think it probably had much more to do with your pushing on your back with an epi than true CPD.

[MNHall]

Your delivery sounds a LOT like mine and the poster above. I'm not sure if you were induced or not, I was. So, IMO, it's not that my baby wouldn't fit, it's that he wasn't ready!!!! I was induced for no good reason, other than my OB convincing me it was a good idea (now I see that it was good for HER schedule). She broke my water at 2cm, and I got an epidural shortly after that and spent the next 7 hours in bed. I too got to 10cm, no problem, pushed for 2 hours and gave up because my OB again convinced me that after 2 hours of pushing if he hadn't come out, he wasn't going to! (Now I know better since I've read a number of mamas that have pushed longer and gotten their baby out!)

So, in my case it seemed more like a bad chain of events from start to finish that lead to my c-section. Not that my body couldn't birth a baby...because obviously it can...

I DID VBAC for my second! I went into labor on my own and stayed drug free and mobile so allow her to decend...at least that's how I felt! I still did push for 2 hours and I needed assistance getting her out, but, she DID make it out! Oh and by the way, my labor was only approx 4 hours...so take that anti-vbac people...my body was ready!!!! (not including the 2 hours of pushing). LOL!

Sorry, I don't have any statistics either, but it sounds to me like your BIL is another one of those OB's that isn't exactly open to VBAC and choses to put titles like CDP on women just because she had a c-section after trying to deliver vaginally! That bothers me to no end! If they want to call me CPD, then why did I have a successful VBAC?!?!?!?! Uh huh, yeah, answer me that!?!?!?!

[DocsNemesis]

No stats here either. However, there are a LOT of moms on here who had a cesarean for CPD and then went on to have an even bigger baby vaginally. I can also say that its extremely rare for a woman to actually grow a baby too large to birth vaginally. My former, Harvard educated OB told me once that in at least 15 years of practice, he'd only had one mom unable to deliver vaginally. The reason was a pelvic abnormality (I think due to rickets?), not that the baby was too big. He said that its pretty much a myth, that unless mom has other issues-particularly untreated or uncontrolled GD-babies don't grow too big for mom to deliver. That just wouldn't make sense biologically.

It sounds like most of your problem was being stuck flat on your back. Simply flipping on the hands and knees provides more space and some babies with shoulder dystocia will practically fall out once mom moves. I also wonder if you were induced and/or you had an epidural. That also makes a difference. And also, did they direct your pushing? I do HORRIBLY trying to push the way they tell me. It just doesn't work for me. With all but my first I've told them to tell me when its ok to push, but not to direct me past that (I also have only had the urge to push once, so I like to make sure I'm not pushing too early) and the result is a fast delivery. My first I pushed for an hour with, until his heart stopped and they did an episiotomy to get him out. With my 2nd and a horribly tight scar from that episiotomy-AND a bigger baby by half a pound-I pushed her out in 10 minutes. Much much different.

The last thing I'd say is that if you weren't induced, its still possible baby was just not in a great position. It happens. If thats the case, moving around, walking, etc helps to get them into a better position. Even if you're at 10cm's, as long as baby is doing fine theres no reason to section. IF for some reason baby never moved into a good position, went into distress, etc, then I could understand moving to a cesarean, but most doctors won't wait for that.

Have you considered going with a midwife this time? Even if you aren't comfortable with an out of hospital birth, a natural minded CNM can make all the difference. Oh and a doula. With my 2nd, who was induced (as was my first) the midwife made sure I could do everything I wanted, even though 90% of it was against hospital policy. It made a huge difference.

[dlm194]

Well, the Hoskins study cites another study at the end (Allendorf, 1988) which showed a 69% success rate in VBACs after c-sections done at full dilation.

You can read the whole article here (just download the pdf):
http://journals.lww.com/greenjournal...ion_at.18.aspx

It says there were only 102 women in that study (total) but there were only 32 women in that Hoskins study that attempted VBAC after a c-section done at full cervical dilation. So you are supposed to make this very important choice based on 32 women in 1 study? Hmmmm...... I'd tell your BIL that it doesn't sound like it's good "evidence-based medicine."

[langdonslady]

Even the ACOG has finally admitted that shoulder dystocia is totally unpredictable and has nothing to do with baby size (fully half of all cases occur in babies under 8 lbs) and that suspected 'Large baby' is NOT a good reason to perform a cesarean! Yet docs are still using the "big baby" as a reason or at least "your baby is big so you will probably have SD" or if not that, then "you have had SD before so you will probably have it again"
DESPITE the ACOG coming out on all that being rubbish. At any rate, even if Big Baby were a valid reason to deliver by major surgery (and the extra risks that entails), the ultrasound has a whopping 20% error margin for estimating weight, and that is why very often, the "10 lb baby" the OB uses as a way to scare a mama into unnecessary surgery turns out to be an 8 lb baby.

I personally know a mama who consented to a cesarean simply because she had had SD with her prior child, and was scared into believing that that was a good indication that it would happen again this time, by an OB. She was cut for no reason AT ALL even according to the authorities that the doc supposedly respects, and will face having to decide whether to "try" for a VBAC in an institution that is dead-set on keeping her from succeeding at one, or go for a homebirth HBAC, which have a very very high success rate, but everyone will tell her how crazy she is.

I had a 10 lb baby, HBAC. With nuchal arm. And a great, experienced Homebirth Midwife. And it was fine! In fact, the best decision I ever made. His 2nd birthday was yesterday, and each birth day has been nothing short of joy and healing to me.

No guarantees either way, but as I told my hubby, the unforeseeable, rare, *true* emergencies are emergencies whether in a hospital or not, and being in a hospital doesn't lessen the risks of those, but does increase the risks of fear tactics and pressures stalling my labor, bad positions messing with the baby's position (the iagtrogenic or "doctor-caused" malposition mentioned by the other poster), etc. Oh, and you cannot catch hospital super-germs if you and the baby are not at the hospital.

Out of a hospital, I had the best chance by far of a natural, healthy, happy birth.

Ditto to the poster who urged you to look up ICAN. Even if there's not a chapter in your area (as was the case for me) you can get the skinny on anything and everything, both the good and the bad (no sugar-coating there!).

Big hugs from an HBAC mama!

[langdonslady]

Oh, and as for the OB in the family, you are not likely to change his mind. Surgery is his bread and butter, and natural birth is an alien concept to him.

If he has it in him to change his worldview, he will seek out the means to do so, and it would make him a rare and amazingly independent-minded person. But if he doesn't want to, he is not going to, no matter what you say or do. Even if you show him an uncomplicated natural HBAC, he will dismiss it as "they just got lucky!"

Pregnancy hormones make you vulnerable emotionally and psychologically, and far less able to withstand opposition than you would be if not pg. He will feel it is his duty to make you "see reason", and fighting to change his viewpoint while pg is not a battle you can win. Best just agree to disagree and ask him to keep his viewpoints to himself. You can lead a horse to water, but you can't make him drink, and you are unlikely to overcome his training, his peers and their worldviews, and the entire medical institution in America during this pregnancy.

But there are a whole lot of women out there who can tell you that 87% of VBACs most certainly do NOT fail, so long as you are in the right hands.

[mollikins]

Thanks ladies! Sorry I had kind of stepped away from the whole VBAC discussion for a week or so, I was pretty emotional about a confrontation with my DH so I had just let it be for awhile.

I am feeling much better after talking to MY OB, who is awesome. When I told her about DH's reservations and BIL's involvement, she just said 'well, it might help your case that I personally did two VBACs.' I know she is very on board with allowing me a TOL. She said anytime DH wants to come in to discuss it is ok by her.

[mollikins]

In case anyone else is looking for info on this, on the ICAN website I found a citation for this article:

http://www.bjog.org/details/journalA..._stage_of.html

It came out a year after the Hoskins article and indicates a whopping 80% success rate for women whose prior cesarean occurred after full dilation. It specifically excluded women whose prior cesarean occurred after full dilation for fetal distress, which the Hoskins study did not - so I think the findings are even more robust thant the Hoskins article, although the cohort size was smaller (103 vs 232 in the Hoskins study). In addition, 74 women with a prior c-section after failed instrumental delivery (attempted vacuum or forceps) had a 75% success rate!!

[MNHall]

Looks like you found some GREAT info! That's awesome! Thanks for sharing it too!